Letter to the Member States of the High Level Group on Syria

Your Excellencies,

Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing assistance to victims of the Syrian conflict since April 2011, and we welcome the diplomatic negotiations addressing the urgent humanitarian needs in this extremely violent conflict. But we would like to draw your attention to the vital subject of cross-border aid for populations living in opposition-controlled areas in Syria.

An urgent need exists to significantly increase cross-border assistance and to prioritize this issue in negotiations on humanitarian aid. If the government of Syria remains the sole distribution channel for international humanitarian relief efforts, then millions of Syrians will continue to be deprived of adequate assistance, particularly essential medical services.

Today, almost all international humanitarian aid transits through the Syrian capital. United Nations agencies and international aid organisations providing this aid are subject to strict control measures by the Syrian government, which greatly limits the number of international staff in Damascus and rarely authorises them to travel outside Damascus. The government also insists that aid be distributed through state controlled bodies, mainly the Syrian Arab Red Crescent (SARC), which alone evaluate needs and select beneficiaries.

Without a doubt, SARC volunteers and employees have demonstrated exemplary dedication and professionalism in their work. They are nevertheless under great pressure from the Syrian government and its policy of limiting or prohibiting the distribution of humanitarian aid—particularly medical aid—to areas controlled by the opposition. Intense fighting and the fragmentation of opposition groups, some of which are deeply suspicious of foreigners and of aid deliveries sanctioned by the government, present further obstacles to getting assistance across frontlines. The hostage-taking of humanitarian workers in opposition controlled areas has also clearly been detrimental.

These obstacles have led to the almost complete blocking of aid for people in enclaves that are controlled by opposition groups and are surrounded by government forces. This is the case in the besieged neighbourhoods of Homs and Ghouta where 200,000 people have struggled for months to survive with little to no assistance.

In the opposition-held areas close to Syria’s neighbours, five to seven million people receive no medical assistance and very little relief aid from Damascus. They are less isolated than the enclaves, largely because of the humanitarian role of neighbouring states, especially Turkey. Turkish hospitals treat hundreds of wounded every month. Turkish authorities have allowed the transfer of food, drugs, tents and blankets by international NGOs and by Syrian organisations working in opposition-held territory, despite the objection of Damascus. However, this assistance falls far short of urgent needs.

For example, in Aleppo and Idlib Governorates, tens of thousands of displaced persons are crammed into tented camps without adequate sanitation facilities. Field hospitals and ambulance services have been targeted since the beginning of the crisis and lack both personnel and medical supplies to care for the hundreds of people wounded daily in indiscriminate bombardments. The destruction and closure of district hospitals has deprived countless patients of vital medical care. The public health system has collapsed. The national immunisation programme has been suspended, as a polio outbreak spreads across the country.

Fewer than a dozen international NGOs, including MSF, are able to provide assistance through neighbouring countries to the populations living in these opposition-controlled areas.

United Nations agencies do not provide such cross-border aid, fearful that their operations in Damascus will suffer reprisals. The complex and insecure environment also limits the provision of assistance; for example, some armed groups block aid access to Kurdish and isolated Shiite communities. However, the work of international NGOs, including MSF, shows that it is indeed possible to engage with opposition groups—even the most radical—in order to directly help the sick, wounded, and displaced.

Although the needs increase on a daily basis, the meager cross-border assistance risks grinding to a halt. The few international NGOs that are present face increasing difficulties to bring teams and equipment across borders into Syria. UN agencies appear to have given up negotiating cross-border access to people living in opposition-held areas.

We therefore urgently call on you to support the efforts of all humanitarian organisations, whether they are working from Damascus or from neighbouring countries. While it is essential to help humanitarian organisations in Damascus to overcome blockages to delivering assistance to enclaves and hard-to-reach areas, it is just as vital to increase the provision of humanitarian aid across borders directly to the population living in opposition held areas, particularly from Turkey.

We also ask you to recognise the important humanitarian role played by Syria’s neighbours, who bear the brunt of this humanitarian crisis, and to encourage them to facilitate the transit of humanitarian teams and material across their borders.

Finally, we call on you to prompt UN agencies to do more to assist populations living in opposition-held areas, at the very least by providing food, medicine, winter tents, blankets and other basic necessary items, at the borders of Syria.

We thank you for your attention to this urgent matter. 

Dr. Joanne Liu
President of MSF International

"United Nations agencies do not provide such cross-border aid, fearful that their operations in Damascus will suffer reprisals... However, the work of international NGOs, including MSF, shows that it is indeed possible to engage with opposition groups—even the most radical—in order to directly help the sick, wounded, and displaced."

Dr. Joanne Liu